Benign Prostatic Hyperplasia

Alpha-adrenergic blockers (Terazosin (Hytrin))?

Dose: - Start with 1 mg at bedtime, then 1-5 mg/day (maximum: 20 mg/day)

Who is affected by BPH?

Generally seen in older men, it is the most common nonthreatening neoplasm in men. It usually affects men 40 years old and older.

What is an example of an androgen?

dihydrotestosterone (DHT)

What is dutasteride?

Dutasteride is a 5 alpha-reductase enzyme inhibitor. It works by lowering levels of a hormone called dihydrotestosterone (DHT), which is a major cause of prostate growth. Lowering DHT leads to shrinkage of the enlarged prostate gland.

Discharge Instructions after Prostate Surgery (Work)?

If work is not strenuous, you may return in 4 weeks; otherwise, wait 6-8 weeks.

Pg. 289 on Volume 1 for Medications for BPH

Pg. 289

Dx test (Urine culture) purpose?

To assess for infection

Dx test (Creatinine level) purpose?

To assess for kidney damage

What is hydronephrosis?

accumulation of urine in the renal pelvis because of obstruction

The nurse is caring for a client who was recently remarried. He is being discharged today after having undergone prostate surgery. He asks the nurse​ privately, with some​ embarrassment, when he can resume sexual intercourse with his wife. Which response by the nurse is the most​ appropriate?

"You can resume sexual activity 6 weeks after surgery." In order to prevent​ bleeding, sexual activity should not be resumed until 6 weeks after surgery. Another teaching point for the client​ and/or partner is that after resuming​ sex, the ejaculate will flow back into the bladder so the client will express little or no semen.

Explain risk factors (Race/ Ethnicity)?

- Black and Hispanic men develop symptoms earlier in life than White men. - Asian men develop symptoms later in life than White men.

Side effects of dutasteride?

- Decreased sexual desire or ability - Decreased amount of semen released during ejaculation.

What is the most frequently used diagnostic test for BPH?

- Digital Rectal Examination (DRE)

How are the nodules formed?

- Hyperplasia - Hypertrophy - Gradual increase (leading to compression of the urethra)

Explain risk factors (Presence of testes)?

- Men whose testes were removed before puberty (e.g., because of cancer) do not develop BPH. - Men whose testes were removed later in life experience shrinkage of the prostate gland rather than hyperplasia.

Clinical therapies for Storage BPH?

- Pharmacologic therapy - Lifestyle changes

Clinical therapies for Voiding BPH?

- Pharmacologic therapy - Lifestyle changes

Clinical therapies for Urinary retention?

- Surgery

Explain risk factors (Age)?

- Symptoms are rarely seen before the age of 40. - More than 50% of men in their 60s have symptoms of BPH. - 90% of men in their 70s and 80s have symptoms of BPH.

Which information should the nurse include in the discharge instructions for a client who has undergone prostate​ surgery?

- The nurse should include information about activitylong dash—the healing period lasts 4dash-8 weeks. - The client should be informed when to report bleeding to the healthcare provider. - Teaching the client how to keep bowel movements regular and soft is important in keeping pressure off the prostate area. - The client should be informed to abstain from sexual intercourse for 6 weeks after surgery.

What are risk factors for developing benign prostatic hyperplasia​ (BPH)?

- The risk of developing BPH increases with​ age, generally after the age of 40. - Men who still have their testes are at risk for BPH. - Race may be a factor in​ BPH: Black and Hispanic males tend to develop BPH earlier than White​ males, while Asian males develop symptoms later.

Which surgical option for treating benign prostatic hyperplasia​ (BPH) utilizes​ low-level radio frequency through twin needles to burn away a region of the enlarged​ prostate

- Transurethral needle ablation (TUNA) utilizes​ low-level radio frequency through twin needles to burn away a region of the enlarged prostate

What diagnostic tests are used to identify benign prostatic hyperplasia​ (BPH)?

- Urinalysis is done to identify the presence of white and red blood cells or bacteria in the urine. - An ultrasound or postvoid catheterization is performed to determine residual urine volume. - A PSA test screens for prostate​ cancer, and a digital rectal exam assesses the external surface of the prostate.

What are some complications that may develop from BPH?

- can develop into chronic urinary dysfunction - continued hydroureter - may lead to development of diverticula of the bladder - Infection may develop in the diverticula and in retained urine - Hydronephrosis - Renal Failure

What does DHT?

- produced by the prostate from testosterone and facilitates prostate growth. - as the man ages, the prostate becomes more sensitive to DHT, thus enabling hyperplasia.

What are the growth factors of the nodules?

- urethral resistance to effects of BPH - intravesical pressure during urination - strength of the detrusor muscle - man's neurological functioning - general health

What are some risk factors for BPH?

1) Age 2) Presence of testes 3) Race/ ethnicity

Postoperative Interventions for client with BPH?

1) Assessing and managing the client's pain, which may include bladder spasms and incisional pain 2) Administering pain medication as indicated (e.g., analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), belladonna and opium suppositories) 3) Assisting with leg exercises and ambulation as ordered 4) Monitoring for hemorrhage in the first 24-48 hours post TURP 5) Monitoring and maintain three-way urinary catheter with continuous bladder irrigation (CBI). 6) Assessing for TURP syndrome (hyponatremia, decreased hematocrit, hypertension, bradycardia, and confusion caused by absorption of irrigation fluid during and after surgery), which may lead to dysrhythmias and seizures if left untreated 7) Assessing amount, color, and consistency of urinary output 8) Assessing for incisional bleeding or infection if retropubic prostatectomy was performed 9) Meticulous wound care of incision near the anus 10) Consulting skin care specialist if skin irritation results from saturated dressings 11) Avoiding rectal temperature taking and enemas for perineal prostatectomy

Preoperative interventions for client with BPH?

1) Assessing the client's knowledge about surgical procedure. 2) Explaining perioperative procedures, including postoperative care (e.g., informed consent, urinary catheter, pneumatic compression stockings, bowel preparation)

The nurse is providing discharge instructions to a postoperative client who is being discharged to home with an indwelling urine catheter. Which will the nurse include in the teaching for this​ client?

1) Avoid strapping on the leg bag too tightly. 2) Place a soft cloth between the leg bag and thigh. 3) Change from a daytime leg bag to a larger drainage bag at night. 4) Empty the leg bag every 3dash-4 hours. Changing to a larger bag at night permits gravity drainage and keeps urine from backing up in the bladder. If the leg bag is strapped on too​ tightly, it can impede venous return in the leg. Placing a soft cloth between the bag and the thigh protects the skin and absorbs any wetness. Emptying the leg bag every 3-4 hours prevents overfilling.

Considerations related to clients with BPH (Assessment of Physical Examination)?

1) Digital rectal exam (DRE) 2) Urinalysis 3) Postvoid catheterization or ultrasonography 4) Serum creatinine levels 5) Prostatic-specific antigen (PSA) levels

A client with benign prostatic hyperplasia​ (BPH) is scheduled for minimally invasive surgery for his condition. He is not convinced that he really needs this procedure. He asks the​ nurse, "What​'s the worst that can happen if I don​'t have the ​procedure?" The nurse would base the response on which​ complications?

1) Hydroureter 2) Hydronephrosis 3) Diverticula Several complications may occur if the mass is not reduced in size. The bladder becomes more distended. Diverticula​ (saclike projections of​ mucosa) may appear on the bladder wall. The distention can cause hydroureter​ (distention of the ureter with​ urine) and hydronephrosis​ (accumulation of urine in the renal​ pelvis). These can all result in infection.

Examples of nursing diagnosis for client with BPH?

1) Impaired urinary elimination 2) Increased risk for infection 3) Alterations in urinary retention 4) Potential for urinary incontinence 5) Alterations in comfort 6) Potential for enhanced knowledge

The nurse is preparing a client for a transurethral needle ablation​ (TUNA) for benign prostatic hyperplasia​ (BPH). While reviewing the medical​ record, the nurse notes that which findings support the rationale for this surgical procedure for the​ client?

1) It is minimally invasive. 2) It does not cause impotence. 3) It does not cause incontinence.

Considerations related to clients with BPH (Assessment of Health History)?

1) Risk factors including age: All men over the age of 40 should be evaluated. 2) Urinary elimination patterns and manifestations 3) Hematuria 4) Pain 5) Symptoms assessed on a 1-5 scale with the International Prostate Symptom Score (IPSS)

Non-surgical nursing interventions for client with BPH?

1) Teaching the client self-care regarding medication, side effects, and symptoms to report to healthcare provider. 2) Providing emotional support and responding to the client's questions.

For the client with BPH who successfully achieves the identified client goals and outcomes, examples of nursing observations during the evaluation phase may include the following:

1) The client experiences normal urinary flow and volume. 2) The client has no signs of urinary tract infection. 3) The client maintains urinary continence. 4) The client rates pain at ≤ 3 on a scale of 0-10. 5) The client demonstrates proper care of indwelling catheter and drainage bag.

Examples of client goals and outcomes for client with BPH?

1) The client will experience normal urinary flow and volume. 2) The client will have no signs of urinary tract infection. 3) The client will maintain urinary continence. 4) The client will rate pain at ≤ 3 on a scale of 0-10. 5) The client will demonstrate proper care of indwelling catheter and drainage bag.

Other diagnostic tests used to identify BPH?

1) Urinalysis 2) Urine culture 3) Urine flow rate test 4) Postvoid residual urine test 5) Uroflowmetry 6) Prostate specific antigen (PSA) level 7) Cystoscopy 8) Creatinine level

Lifestyle changes that may be appropriate for men with mild BPH include:

1) Urinating when the urge first occurs 2) Avoiding alcohol and caffeine 3) Drinking small amounts of fluids throughout the day 4) Avoiding fluid intake within 2 hours of bedtime 5) Avoiding over-the-counter medications that contain 6) decongestants or antihistamines 7) Exercising regularly, including Kegel exercises 8) Minimizing stress

Discharge Instructions after Prostate Surgery (Please call immediately if:)?

1) You are unable to urinate. 2) Bleeding is not controlled by fluids and rest or is excessive. 3) You have chills and fever or severe abdominal pain. 4) Your scrotum becomes swollen and tender. 5) You have pain in one calf, chest pain, or difficulty breathing.

5-Alpha-reductase inhibitors?

5-Alpha-reductase inhibitors block the action of 5-alpha-reductase, the enzyme that converts testosterone into dihydrotestosterone, which has greater affinity for androgen receptors. The activity of 5-alpha-reductase inhibitors results in increased levels of testosterone and decreased levels of dihydrotestosterone. 5-Alpha-reductase inhibitors are used to treat baldness, prostate hyperplasia and prostate cancer.

What is renal insufficiency?

A condition in which the kidneys lose the ability to remove waste and balance fluids.

What is hyponatremia?

A condition that occurs when the level of sodium in the blood is too low.

Discharge Instructions after Prostate Surgery (Urination)?

After your catheter is removed, you may experience some burning, stinging, or leakage for several weeks, and you may pass small blood clots occasionally. These symptoms will disappear as the area heals. It is best to use pads to control leakage.

An older adult client is admitted for a transurethral resection of the prostate​ (TURP) to treat benign prostatic hyperplasia​ (BPH). Which item in the client​'s health history placed him at risk for developing​ BPH?

Age is the most common risk factor for BPH. Almost all men will develop BPH if they live long enough. There may be a racial component as​ well, because Black and Hispanic men develop BPH earlier than White​ men, but Asian men develop it later.​

What are Alpha-adrenergic blockers?

Alpha blockers relax certain muscles and help small blood vessels remain open. They work by keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins. Blocking that effect causes the vessels to remain open and relaxed. This improves blood flow and lowers blood pressure. Because alpha blockers also relax other muscles throughout the body, these medications can help improve urine flow in older men with prostate problems. Patient may experience orthostatic hypotension

What hormone influences the growth of the prostate?

Androgens: hormones involved in development and maintenance of male sex characteristics.

Describe surgery for BPH (Balloon urethroplasty)?

Balloon-tipped catheter used to widen the urethra, relieving pressure

What is BPH?

Benign Prostatic Hypertrophy

Clinical manifestations of (Urinary retention)?

Bladder distention, diverticula, ureter obstruction, bladder or kidney infection, hydroureter, hydronephrosis, renal insufficiency

Discharge Instructions after Prostate Surgery (Bleeding)?

Bleeding can occur any time after surgery. It is fairly common after a bowel movement, coughing, or increased exercise. If you notice blood in the urine, increase fluids and rest until the urine is clear. If heavy bleeding plugs the channel, call the care provider immediately. Avoid aspirin and NSAIDs for at least 2 weeks.

A client tells the nurse that he has had open double "problems with the prostate" for many years. Which clinical manifestations experienced by the client would necessitate the need for surgery for benign prostatic hyperplasia​ (BPH)?

Candidates for prostate surgery are clients who have: 1) urinary​ retention 2) hematuria 3) bladder​ stones 4) renal insufficiency secondary to BPH.

A client recently diagnosed with benign prostatic hyperplasia​ (BPH) tells the nurse that the provider told him he can no longer take the decongestant medication he has routinely used for the sniffles. He asks the nurse to explain why he should avoid this medication. The nurse would base the response to the client on which​ rationale?

Causes urinary retention Several classes of medications can precipitate urinary retention in men with​ BPH, including anticholinergics and​ over-the-counter medications for the common​ cold, such as decongestants

The nurse is educating Mr.​ Blane, a​ 68-year-old African American​ client, and his wife about nonpharmacologic therapies they can implement for his mild benign prostatic hyperplasia​ (BPH). Which is an appropriate lifestyle change for the nurse to include in the teaching session with Mr.Blane and his​ wife?

Clients with mild BPH may have symptom improvements by: 1) avoiding drinking fluids within 2 hours of​ bedtime 2) urinating at the first​ urge 3) avoiding alcohol and​ caffeine 4) exercising​ regularly 5) reducing​ stress, and other measures

A client is admitted to the hospital for elective knee surgery to be performed the following day. The client tells the nurse that he has benign prostatic hyperplasia​ (BPH). Which assessment findings support the diagnosis of​ BPH?

Clinical manifestations of BPH include weak urinary​ stream, increased time to​ void, hesitancy, incomplete bladder​ emptying, postvoid​ dribbling, frequency,​ urgency, incontinence,​ nocturia, dysuria, and bladder pain.

Alpha-adrenergic blockers (Tamsulosin (Flomax))?

Dose: - 0.4 mg 30 minutes after a meal (maximum: 0.8 mg/day)

5-alpha reductase inhibitors (Dutasteride (Avodart))?

Dose: - 0.5 mg/day Adverse effects: - Sexual dysfunction, decreased libido, decreased ejaculate volume

Alpha-adrenergic blockers (Prazosin (Minipress))?

Dose: - 1 mg twice or four times a day Adverse effects: - First-dose phenomenon (severe hypotension and syncope) - tachycardia

Alpha-adrenergic blockers (Doxazosin (Cardura))?

Dose: - 1-8 mg/day Adverse effects: - Orthostatic hypotension - headache - dizziness

5-alpha reductase inhibitors (Finasteride (Proscar))?

Dose: - 5 mg/day

A client underwent a transurethral resection of the prostate​ (TURP) 24 hours ago. The nurse providing care for him would be especially vigilant in observing for which​ complications?

During the first 24-48 hours after a​ TURP, the client should be monitored closely for hemorrhage​ (frankly bloody urine​ output), the presence of large blood​ clots, decreased urinary​ output, increased bladder​ spasms, decreased hemoglobin and​ hematocrit, tachycardia, and hypotension.

What is another hormone that is associated with the development of BPH?

Estrogen (an increase of)

Clinical manifestations of (Storage BPH)?

Frequency, urgency, incontinence, nocturia, dysuria, bladder pain

What is DRE (Digital Rectal Exam)?

In this examination, the healthcare provider inserts a gloved, lubricated finger into the client's rectum and palpates the prostate gland.

What are the manifestations of BPH?

Include symptoms related to: - Voiding - Storage - Urinary Retention

Describe surgery for BPH (Intraurethral stents)?

Insertion of stent to widen the urethra and relieve pressure

Discharge Instructions after Prostate Surgery (Bowel Movements)?

Keep bowel movements regular and soft to prevent pressure on the prostate area. Drink fruit juices and take mild laxatives or stool softeners as ordered.

A client with mild benign prostatic hyperplasia​ (BPH) tells the nurse that he prefers to do things open double quote"naturallyclose double quote" and doesn​'t want to take medication for his condition. He asks her if there are some things he can do to help his BPH without drugs. Which lifestyle changes used in the treatment for BPH would the nurse include in the response to the​ client?

Lifestyle changes that may help clients with mild BPH include avoiding alcohol and​ caffeine, exercising​ regularly, including Kegel​ exercises, avoiding drinking fluids within 2 hours of​ bedtime, and reducing stress

What are NSAIDS?

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are more than just pain relievers. They also help reduce inflammation and lower fevers. They prevent blood from clotting, which is good in some cases but not so beneficial in others.

Prostatic tissue growth can result in __________?

Partial or complete obstruction of urine from the bladder.

Herbal therapy for BPH?

Pytotherapy - "Saw palmetto berries"

What is a resection?

Resection is the medical term for surgically removing part or all of a tissue, structure or organ.

Discharge Instructions after Prostate Surgery (Diet)?

Resume your normal diet. Increase fluids to 10 glasses (8 oz) daily. Avoid alcohol unless otherwise advised by your physician.

The client has been prescribed dutasteride​ (Avodart) for benign prostatic hyperplasia​ (BPH). Which potential adverse effects would the nurse include in the medication teaching for this​ medication?

Side effects of​ 5-alpha reductase​ inhibitors, such as dutasteride​ (Avodart) and finasteride​ (Proscar), may include​ impotence, decreased​ libido, and decreased volume of ejaculate

Describe surgery for BPH (Transurethral incision of the prostate (TUIP))?

Surgery to split the gland, thereby reducing pressure on the urethra; no tissue removed; used with smaller prostate glands

Describe surgery for BPH (Open Surgery)?

Surgical option when the prostate is extremely large and other methods will not work

A client who has just undergone transurethral resection of the prostate​ (TURP) has developed TURP​ syndrome, according to the healthcare provider. Which findings during the nursing assessment support this​ diagnosis?

TURP syndrome occurs when the client absorbs the irrigation fluids during and after surgery. Clinical manifestations are​ hyponatremia, decreased​ hematocrit, hypertension,​ bradycardia, nausea, and confusion. If not treated​ promptly, TURP syndrome may result in dysrhythmias​ and/or seizures.

Which androgen mediates prostatic growth at all​ ages?

The androgen that mediates prostatic growth at all ages is dihydrotestosterone​ (DHT), which is formed in the prostate from testosterone.​

Discharge Instructions after Prostate Surgery (Activity)?

The healing period lasts from 4 to 8 weeks. Avoid strenuous activity and heavy lifting. Except for short rides, do not drive for 2 weeks. Do take long walks; take stairs slowly and carefully. Continue exercises that you did in the hospital to prevent blood clots in the legs. You can take showers, but avoid tub baths while the catheter is in place.

Which elements of a health history for a client with benign prostatic hyperplasia​ (BPH) may be​ documented?

The health history should include: - risk​ factors - urinary elimination patterns and​ manifestations - hematuria - pain.

John Murphy is a​ 59-year-old white male who is being discharged from the hospital with the diagnosis of benign prostatic hyperplasia​ (BPH). Which common signs and symptoms of BPH would the nurse include in the discharge teaching for Mr.​ Murphy?

The most common clinical manifestations of BPH are: 1) urinary​ retention 2) obstruction of urinary​ flow 3) hesitancy

Mr. Tupper is a​ 70-year-old client who just underwent a transurethral resection of the prostate​ (TURP). His catheter was just​ removed, and you are conducting postoperative teaching with him. Which teaching point will you include in the​ session?

The nurse should teach the client to start and stop the urine stream during each void and to perform Kegel exercises.

What is the function of the prostate?

The prostate secretes fluid that nourishes and protects sperm. The prostate is a walnut-sized gland located between the bladder and the penis. The prostate is just in front of the rectum. The urethra runs through the center of the prostate, from the bladder to the penis, letting urine flow out of the body.

Dx test (Urinalysis) purpose?

To assess for presence of white and red blood cells and bacteria

Dx test (Urine flow rate test) purpose?

To assess rate of urine flow

How does the detrusor muscle compensate for resistance in urine flow caused by the obstruction?

To compensate for resistance in urine flow caused by the obstruction, the detrusor muscle hypertrophy, resulting in decreased bladder compliance and bladder instabilit

Dx test (Postvoid residual urine test) purpose?

To determine volume of residual urine

Dx test (Uroflowmetry) purpose?

To measure urine flow, which will be diminished if obstruction is present

Discharge Instructions after Prostate Surgery (Sexual Intercourse)?

To prevent bleeding, do not have sex for 6 weeks after surgery. You may still have erections even with the catheter in place. When you resume sex, ejaculate will flow back into the bladder, so you will express little or no semen.

Dx test (Prostate specific antigen (PSA) level) purpose?

To screen for prostate cancer

Dx test (Cystoscopy) purpose?

To visualize bladder and urethra for obstruction and rule out other causes of urinary symptoms

What is the TURP syndrome?

Transurethral Resection of the Prostate (TURP) Syndrome is a rare but potentially life-threatening complication of a transurethral resection of the prostate procedure. It occurs as a consequence of the absorption into the prostatic venous sinuses of the fluids used to irrigate the bladder during the operation.

Describe surgery for BPH (Laser surgery)?

Use of a laser through a cystoscope to remove tissue from enlarged prostate gland

Describe surgery for BPH (Transurethral resection of the prostate (TURP))?

Use of a resectoscope and electrocautery to remove prostate tissue

Describe surgery for BPH (Transurethral needle ablation (TUNA))?

Use of low-level radio frequency through twin needles to burn away a region of the enlarged prostate

Clinical manifestations of (Voiding BPH)?

Weak or intermittent urinary stream, hesitancy, incomplete emptying, dribbling at the end of urination, straining during urination

What are 5-alpha reductase inhibitors?

a class of drugs with antiandrogen effects

What is prostatodynia?

a condition in which the client experiences the symptoms of prostatitis, but shows no evidence of inflammation or infection *THESE DISORDERS ARE NOT DIRECTLY RELATED TO BPH AND MAY OR MAY NOT BE SEEN IN CLIENTS WITH BPH.*

What is neoplasm?

a new and abnormal growth of tissue in some part of the body, especially as a characteristic of cancer.

What is BPH to the body?

a noncancerous growth of the prostate gland that blocks the flow of urine from the urethra, making urination challenging. can be due to increase in the size or numbers of the cells of the prostate increase in the bladder's size can lead to loss of elasticity or bladder tone, which can lead to hypertrophy

What is hydroureter?

bladder distention that results from retention of urine

What is hyperplasia?

increase in number of cells

What is hypertrophy?

increase in size of individuals cells

What is prostatitis?

inflammation of the prostate gland

What is diverticula?

saclike projections of mucosa though the muscular layer of the bladder, similar to gastrointestinal diverticula

How does the prostate grow?

through the formation and growth of nodules in the periurethral glands, located within the prostate